María Isabel Baena Parejo

Indicadores de riesgo de morbilidad prevenible causada por medicamentos

Objetivos: Los objetivos principales de este trabajo son: estudiar la frecuencia de los 43 indicadores de riesgo de morbilidad prevenible causada por medicamentos (RMPM), identificados previamente, en pacientes con tratamiento farmacologico que acuden a un servicio de urgencias hospitalario; describir las caracteristicas de los pacientes en los que estaba presente el indicador, y establecer si el motivo de consulta y la gravedad de los pacientes coinciden con alguna de las situaciones clinicas descritas en los indicadores. Metodo: Estudio observacional descriptivo transversal que utiliza la base de datos de un estudio multicentrico sobre prevalencia de resultados negativos de la medicacion en el Hospital Universitario Central de Asturias. Criterios de inclusion de pacientes: a) estar tomando un medicamento relacionado con las situaciones clinicas descritas en los indicadores; b) presentar una enfermedad relacionada con los indicadores de resultados de problemasrelacionados con medicamentos, y c) acudir a urgencias por un motivo relacionado con los indicadores. Resultados: Se estudiaron 436 pacientes. El perfil del paciente con indicador es una mujer mayor de 64 anos que utiliza cuatro o mas medicamentos. Cincuenta y siete pacientes (13,1%) presentaban alguna de las situaciones descritas en los indicadores. Un 28% tenia un indicador relacionado con AINE, un 26,3% con asma/EPOC, un 8,8% con osteoporosis y un 7% con uso dedigoxina y medicamentos psicotropos. El 68,4% de los pacientes con indicador mostraban una gravedad leve, un 7% moderada y un 19,3% grave. Conclusiones: Se hallaron 17 indicadores (39,5%) en 57 pacientes (13%) de los que acudieron al servicio de urgencias. En mas del 80% (46) de esos pacientes el motivo por el que acudierona urgencias fue presentar alguna situacion descrita en los indicadores. El 25% (14) de los pacientes con indicador presentaban una situacion grave y tuvieron que ser ingresados. Los pacientesdel grupo con indicador presente tenian mas edad, ingresaban mas y usaban mas medicamentos de media.

Medication list assessment in Spanish hospital emergency departments.

BACKGROUND Medication errors lead to morbidity and mortality among emergency department (ED) patients. An inaccurate medication history is one of the underlying causes of these errors. OBJECTIVES This study was performed to determine the prevalence of patients with discrepancies between the medical list information contained in the clinical history compiled on admission to the ED and the list of medications patients are actually taking, to characterize the discrepancies found, and to analyze whether certain factors are associated with the risk of discrepancies. METHODS We conducted a cross-sectional, descriptive, observational, multicenter study with an analytic component in the EDs of 11 hospitals in Spain. We compared pharmacist-obtained medication lists (PML) with ED-obtained medication lists (EDML). Discrepancy was defined as one or more differences (in drug or dosage or route of administration) between the EDML and PML. The endpoints were the proportion of patients with discrepancies in their home medical lists, and the prevalence of certain factors among patients with discrepancies and those without. RESULTS We detected 1476 discrepancies in 387 patients; no discrepancies were found in 20.7%. The most frequent discrepancies involved incomplete information (44.2%) and omission (41.8%). In the bivariate analysis, age, number of medications, and Charlson comorbidity score were significantly associated with discrepancy. In the multivariate analysis, number of medications and hospital were the variables associated with discrepancy. CONCLUSIONS The EDML differed from the list of medications patients were actually taking in 79.3% of cases. Incomplete information and omission were the most frequent discrepancies. Age, number of medications, and comorbidities were related to the risk of discrepancies.

Risk indicators of preventable morbidity related to drug utilization

OBJECTIVE To select clinical situations that can be used as risk indicators of preventable morbidity caused by drugs at the community pharmacies, and to study their acceptability, in terms of pertinence and relevance. METHODS We used the Delphi technique, in 2 rounds, by a panel of 14 medical doctors and pharmacists experts, to study the relevance of 68 types of clinical situations as risk indicators of preventable morbidity related to drug utilization used by health professionals in community pharmacies, with scientific evidence of foreseeable adverse result, frequent situations in ambulatory care and with controllable cause and result. RESULTS 43 of the 68 indicators were considered usable and pertinent. The indicators referred three areas: drug type (medications of narrow therapeutic margin, with individualized dose and adverse reactions frequent and severe), health problem (chronic problems, especially asthma, cardiac, thyroid and prostate illness, and pain), and patient (old or with several medications. Pharmacists systematically overvalued some indicators in relation to the doctors, but differences were not significant. CONCLUSIONS Forty-three indicators were selected as valuable to identify situations of preventable morbidity related to drug utilization.

Value of α‑fetoprotein as an early biomarker for treatment response to sorafenib therapy in advanced hepatocellular carcinoma

Sorafenib is an oral multikinase inhibitor with antiangiogenic and antiproliferative properties, and is used as the first-line treatment for patients with advanced hepatocellular carcinoma (HCC). Previous studies have identified an improvement in overall survival and progression-free survival in patients with a manageable toxicity profile. α-fetoprotein (AFP) has been revealed to be of great diagnostic and predictive value for tumour staging in multiple studies; however, its role as a predictive factor of response to treatment with sorafenib is not entirely clear. The present study aimed to determine the effectiveness of sorafenib and investigate the value of AFP as a predictive factor of early response to sorafenib in patients with HCC. Effectiveness was analysed based on median overall survival (mOS) time, while to analyse the possible predictive value of AFP, patients were classified into two groups: Non-responders (≤20% AFP reduction) and responders (>20% AFP reduction) at 6-8 weeks of treatment when compared with basal AFP level. For assessment of toxicity, any adverse effects were recorded. A total of 167 patients were included, who collectively exhibited a mOS time of 11 months with a median treatment duration of 5 months. The mOS time was significantly higher for patients with better hepatic function (12 months in cases of Child-Pugh score A vs. 8 months in cases of Child-Pugh score B; P=0.03) and with basal AFP values ≤200 ng/ml (14 months vs. 8 months in patients with AFP levels >200 ng/ml; P=0.01). A >20% reduction of AFP at 6-8 weeks was determined to be a positive predictive factor upon multivariate analysis (P=0.002), obtaining, for the responder patients, an mOS of 18 months compared with 10 months (P=0.004) for the non-responders. The main adverse reactions were hand-foot syndrome (35/167; 21%), diarrhoea (39/167; 23.4%), anorexia (29/167; 17.4%) and arterial hypertension (30/167; 18%). In conclusion, a >20% drop in AFP at 6-8 weeks may be useful as a predictive factor of response to sorafenib, as indicated by its association with longer survival times in patients with advanced HCC following treatment with sorafenib in the present study.

Opinión de los veterinarios de atención primaria de Andalucía sobre la gestión de su ejercicio profesional

FUNDAMENTO: Este trabajo describe la opinion de los veterinarios de Andalucia sobre la organizacion y gestion de su ejercicio profesional y se identifican soluciones para los problemas encontrados, con el fin de aportar elementos de planificacion y gestion frente a las reformas contempladas en el nuevo Plan Estrategico del Servicio Andaluz de Salud (SAS). METODO: Estudio descriptivo de opinion, utilizando un cuestionario autoadministrado con el total de los veterinarios de Atencion Primaria (AP) de Andalucia (incluidos activos con al menos un ano de experiencia, excluidos los sustitutos). Se describieron sus caracteristicas personales, su opinion de los factores de gestion de su ejercicio profesional. Tambien se describen las propuestas de mejora a los problemas encontrados. RESULTADOS: Mas del 70% dicen conocer los objetivos, aunque solo los coordinadores los consideran claramente motivadores del ejercicio. Piensan que los indicadores de actividad no incluyen criterios de calidad, ni permiten evaluar la actividad que realizan. Creen que las aportaciones de otros miembros del equipo multidisciplinar mejoran su trabajo y apuestan por mantener su actividad en el mismo. Estan satisfechos con la realizacion de su trabajo (en mayor medida los coordinadores). Consideran insuficiente la cantidad de productividad pagada y que esta no es util para incentivarlos. No estan conformes con la formacion que reciben y piensan que su oferta es muy inferior a la de sus companeros asistenciales. La mayoria opina que deberian seguir dependiendo del SAS. CONCLUSIONES: Este colectivo prefiere mantener su actividad en la organizacion actual, aunque mejorando los siguientes aspectos de gestion: oferta de formacion, elementos incentivadores del ejercicio e indicadores de actividad.